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COMMON TOXICITY CRITERIA (CTC) SCALE

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     Grade
  
 TOXICITY 0   1        2    3   4

 Haematology
 
 WBC 
 (x103/l)
  4.0  3.0 - 3.9  2.0 - 2.9  1.0 - 1.9  < 1.0

 Platelets 
 (x103/l)
 WNL  75.0 - normal  50.0 - 74.9  25.0 - 49.9  < 25.0

 Haemoglobin 
 (g/dl)
 WNL  10.0 - normal  8.0 - 9.9  6.5 - 7.9  < 6.5

 Granulocytes/ 
 Bands (x103/l)
  2.0  1.5 - 1.9  1.0 - 1.4  0.5 - 0.9  < 0.5

 Lymphocytes 
 (x103/l)
  2.0  1.5 - 1.9  1.0 - 1.4  0.5 - 0.9  < 0.5

 Haemorrhage  none  mild, no  gross, 1 - 2 units 
 transfusion per 
 episode
 gross, 3 - 4 units 
 transfusion per 
 episode
 massive, > 4 
 units transfusion 
 per episode

 Coagulation
 
 Fibrinogen  WNL  0.99 - 0.75 x N  0.74 - 0.50 x N  0.49 - 0.25 x N  < 0.25 x N

 Prothrombin 
 time (Quick)
 WNL  1.01 - 1.25 x N  1.26 - 1.50 x N  1.51 - 2.00 x N  > 2.00 x N

 Partial thrombo- 
 plastin time
 WNL  1.01 - 1.66 x N  1.67 - 2.33 x N  2.34 - 3.00 x N  > 3.00 x N

 Metabolic
 
 Hyperglycaemia 
 (mg/dl)
 < 116  116 - 160  161 - 250  251 - 500  > 500 or 
 ketoacidosis

 Hypoglycaemia 
 (mg/dl)
 > 64  55 - 64  40 - 54  30 - 39  < 30

 Amylase  WNL  < 1.5 x N  1.5 - 2.0 x N  2.1 - 5.0 N  > 5.0 x N

 Hypercalcaemia 
 (mg/dl)
 < 10.6  10.6 - 11.5  11.6 - 12.5  12.6 - 13.4   13.5

 Hypocalcaemia 
 (mg/dl)
 > 8.4  8.4 - 7.8  7.7 - 7.0  6.9 - 6.1   6.0

 Hypomagnesaemia 
 (mg/dl)
 > 1.4  1.4 - 1.2  1.1 - 0.9  0.8 - 0.6   0.5

 Gastrointestinal
 
 Nausea  none  able to eat 
 reasonable 
 intake
 intake significantly 
 decreased but can 
 eat
 no significant 
 intake
 __

 Vomiting  none  1 episode in 
 24 hrs
 2 - 5 episodes in 
 24 hrs
 6 - 10 episodes 
 in 24 hrs
 > 10 episodes 
 in 24 hrs or 
 requiring paren- 
 teral support

 Diarrhoea  none  increase of 2 - 3 
 stools / day over 
 pre-Rx
 increase of 4 - 6 
 stools / day, or 
 nocturnal stools, 
 or moderate cramping
 increase of 7 - 9 
 stools / day, or 
 incontinence, or 
 severe cramping
 increase of > 10 
 stools / day or 
 grossly bloody 
 diarrhoea, or 
 need for paren- 
 teral support

 Stomatitis  none  painless ulcers, 
 erythema, or 
 mild soreness
 painful erythema, 
 oedema, or ulcers 
 but can eat solids
 painful erythema, 
 oedema, or ulcers 
 and cannot eat 
 solids
 requires paren- 
 teral or enteral 
 support for 
 alimentation

 Liver
 
 Bilirubin (N = 17 ?mol/L)   WNL  -----  < 1.5 x N  1.5 - 3.0 x N  > 3.0 x N

 Transaminase 
 (SGOT, SGPT)
 WNL   2.5 x N  2.6 - 5.0 x N  5.1 - 20.0 x N  > 20.0 x N

 Alk Phos or 
 5 nucleotidase
 WNL  < 2.5 x N  2.6 - 5.0 x N  5.1 - 20.0 x N  > 20.0 x N

 Liver- 
 clinical
 No change 
 from 
 baseline
 -----  -----  precoma  hepatic coma

 Kidney, bladder
 
 Creatinine  WNL  < 1.5 x N  1.5 - 3.0 x N  3.1 - 6.0 x N  > 6.0 x N

 Proteinuria  No change  1 (+) or < 0.3 g% 
 or 3 g/L
 2 - 3 (+) or 0.3 - 
 1.0 g% or 3 - 10 g/L
 4 (+) or > 1.0 g% 
 or > 10g/L
 nephrotic 
 syndrome

 Haematuria  Negative  microscopic 
 only
 gross, no clots 
 no Rx needed
 gross and clots 
 bladder irrigation
 requires trans- 
 fusion or 
 cystectomy

 Weight gain/
 loss
 < 5.0 %  5.0 - 9.9 %  10.0 - 19.9 %   20.0 %  -----

 Pulmonary  none or 
 no change
 asymptomatic, 
 with abnormal- 
 ity in PFTs
 dyspnoea on 
 significant 
 exertion
 dyspnoea at 
 normal level 
 of activity
 dyspnoea at rest

  Cardiac
 
 Cardiac
 arrhythmias
 none  asymptomatic, 
 transient, 
 requiring no 
 therapy
 recurrent or persistent, 
 no therapy required
 requires treatment  requires moni- 
 toring; or hypo- 
 tension, or 
 ventricular 
 tachycardia or 
 fibrillation

 Cardiac function  none  asymptomatic, 
 decline of resting 
 ejection fraction 
 by less than 20 % 
 of baseline value
 asymptomatic, 
 decline of resting 
 ejection fraction 
 by more than 20 % 
 of baseline value
 mild CHF, 
 responsive to 
 therapy
 severe of 
 refractory CHF

 Cardiac ischaemia  none  non-specific T- 
 wave flattening
 asymptomatic, ST 
 and T wave changes 
 suggesting ischaemia
 angina without 
 evidence of 
 infraction
 acute myocardial 
 infarction

 Cardiac- 
 pericardial
 none  asymptomatic 
 effusion, no 
 itervention 
 required
 pericarditis (rub, 
 chest pain, ECG 
 changes)
 symptomatic 
 effusion; drainage 
 required
 tamponade; 
 drainage 
 urgently 
 required

 Hypertension  none or 
 no change
 asymptomatic, 
 transient increase 
 by greater than 
 20 mm Hg (D) or 
 to > 150 / 100 if 
 previously WNL. 
 No treatment 
 required.
 recurrent or persistent 
 increase by greater 
 than 20 mm HG (D) or 
 to > 150 / 100 if 
 previously WNL. No 
 treatment required.
 requires therapy  hypertensive 
 crisis

 Hypotension  none or 
 no change
 changes requiring 
 no therapy (incl- 
 uding transient 
 orthostatic hypo- 
 tension)
 requires fluid 
 replacement or other 
 therapy but not 
 hospitalisation
 requires therapy 
 and hospitalisation; 
 resolves within 48 
 hours of stopping 
 the agent
 requires therapy 
 and hospitalis- 
 ation for > 48 hrs 
 after stopping 
 the agent

 Neurologic
 
 Neuro: sensory  none or 
 no change
 mild paraesthesias; 
 loss of deep 
 tendon reflexes
 mild or moderate 
 objective sensory 
 loss moderate 
 paraesthesias
 severe objective 
 sensory loss or 
 paraesthesias that 
 interfere with 
 function
 -----

 Neuro: motor  none or 
 no change
 subjective weak- 
 ness; no objective 
 findings 
 mild objective 
 weakness without 
 significant impair- 
 ment of function
 objektive weak- 
 ness with 
 impairment of 
 function
 paralysis

 Neuro: cortical  none  mild somnolence 
 or agitation
 moderate somnolence 
 or agitation
 severe somnolence, 
 (>50 % waking 
 hours), agitation, 
 confusion, 
 disorientation or 
 hallucinations
 coma, seizures, 
 toxic psychosis

 Neuro: cerebellar  none  slight 
 incoordination, 
 dysdiadochokinesia
 intention tremor, 
 dysmetria, slurred 
 speech, nystagmus
 locomotor ataxia  cerebellar 
 necrosis

 Neuro: mood  no change  mild anxiety 
 or depression
 moderate anxiety 
 or depression
 severe anxiety 
 or depression
 suicidal 
 ideation

 Neuro: headache  none  mild  moderate or severe 
 but transient
 unrelenting and 
 severe
 -----

 Neuro: constipation  none or 
 no change
 mild  moderate  severe  ileus > 96 hrs

 Neuro: hearing  none or 
 no change
 asymptomatic, 
 hearing loss on 
 audiometry only
 tinnitus  hearing loss 
 interfering with 
 function but 
 correctable with 
 hearing aid
 deafness not 
 correctable

 Neuro: vision  none or 
 no change
 -----  -----  symptomatic 
 subtotal loss 
 of vision
 blindness

 Pain  none  mild  moderate  severe  reg. narcotics

 Skin  none or 
 no change
 scattered macular 
 ot papular 
 eruption or 
 erythema that is 
 asymptomatic
 scattered macular 
 or papular eruption 
 or erythema with 
 pruritus or other 
 associated symptoms
 generalised 
 symptomatic 
 macular, papular 
 or vesicular 
 eruption
 exfoliative 
 dermatitis 
 or ulcerating 
 dermatitis

 Alopecia  no loss  mild hair loss  pronounced or total 
 hair loss
 -----  -----

 Allergy  none  transient rash, 
 drug fever < 38o
 (100.4oF)
 urticaria, drug fever 
  38oC (100.4oF), 
 mild bronchospasm
 serum sickness, 
 bronchospasm 
 requiring parenteral 
 medication
 anaphylaxis

 Local  none  pain  pain and swelling 
 with inflammation 
 or phlebitis
 ulceration  plastic surgery 
 indicated

 Fever of unknown origin  none  37.1 - 38.0o
 98.7o - 100.4o F
 38.1 - 40.0o
 100.5 - 104oF
 > 40.0o
 > 104.0o
 for less than 
 24hrs
 > 40.0o
 (>104oF) for 
 more than 24 hrs 
 or accompanied 
 by hypotension

 Infection  none  mild  moderate  severe  life-threatening

WNL = Within normal limits

 
 Additional events 
  
 Asthenia  analogous to Karnofsky index (WHO grading) 

 Chills  analogous to fever

 Peripheral oedema   analogous to weight gain

 Anorexia  analogous to weight loss

 

 
     
 


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